1/17/13Emergency drug doses – PBS doctor’s bag items - Australian Prescriber

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Emergency drug doses – PBS* doctor’s bag itemsAust Prescr 2012;35:25-7

DRUG INDICATION DOSE

Adrenaline(1000 microgram in 1mL injectionequivalent to 1:1000)

1000 microgram = 1mg

Anaphylaxis 5–10 microgram/kg IM approximates to:Adults:<50 kg 0.25–0.5 mL>50 kg 0.5 mL

Children:10 kg (1–2 years) 0.1 mL15 kg (2–3 years) 0.15 mL20 kg (4–6 years) 0.2 mL30 kg (7–10 years) 0.3 mL

Repeat dose every 5 minutes if no response

Cardiac arrest Adults: 0.5–1mg IVFlush with normal saline to aid entry into the circulation

Children: 10 microgram/kg slow IV(Dilute 1 mL adrenaline injection 1:1000 with 9 mL sodiumchloride (0.9%) and give 0.1 mL/kg)

Atropine(0.6 mg in 1mLinjection)

Severe bradycardia, asystole Adults: 1mg IV, repeat every 3–5 minutes until desired heartrate is reached or to a maximum of 3 mg

Children: 20 microgram/kg IV (maximum dose 0.5 mg),repeat every 5 minutes until desired heart rate is reached orto a total maximum of 1mg

Benztropine(2 mg in 2 mLinjection)

Acute dystonic reactions Adults: 1–2mg IM or IV

Children >3 years: 20microgram/kg IM or IV (maximum1mg). Repeat after 15 minutes if needed.

Benzylpenicillin(600 mg or 3 gpowder, dissolve inwater for injections)

Severe infections, includingsuspected meningococcaldisease

Adults and children ≥10 years: 1.2 g IV or IM

Children aged 1–9 years: 600 mg IV or IM

Children <1 year: 300 mg IV or IM

Chlorpromazine(50 mg in 2 mLinjection)

Acute psychosis, severebehavioural disturbance

Avoid parenteral use – injections cause pain and skinirritation. Use haloperidol instead.

Adults: If there is no alternative, chlorpromazine 25–50 mg(12.5–25 mg in the elderly) can be given by deep IMinjection (buttock or deltoid)

Dexamethasonesodium phosphate(4 mg in 1 mLinjection)

Acute severe asthma Adults: 4–12 mg IV slowly

Severe croup Children: 0.15 mg/kg IM if oral route is not possible

Bacterial meningitis Start before or at the same time as antibiotic

Adults: 10 mg IV

Children aged >3 months: 0.15mg/kg IV

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Diazepam(10 mg in 2mLinjection)

Severely disturbed patients Adults: 5–10mg IV over 1–2 minutes (halve dose in elderly)in a large vein. Repeat if necessary every 5–10minutes(maximum 30mg).

Seizures Adults: 10mg IV slowly in a large vein. Repeat once ifnecessary.10–20 mg rectally if IV access not possible. Repeat once ifnecessary.

Children: 0.2–0.3mg/kg IV slowly in a large vein (maximum10mg). Repeat once if necessary.0.3–0.5mg/kg rectally (maximum 10mg). Repeat once ifnecessary.

Dihydroergotamine(1 mg in 1 mLinjection)

Severe migraine Adults: 0.5–1 mg SC or IM. Repeat every hour if needed(maximum 3 mg daily).

Diphtheria andtetanus boostervaccine(0.5 mL pre-filledsyringe)

Tetanus prophylaxis Adults and children >8 years: 0.5 mL IM

Frusemide(20 mg in 2 mLinjection)

Left ventricular failure, acutepulmonary oedema

Adults: 20–40 mg IV slowly or IM

Glucagon(injection kitcontaining 1 mgglucagon and 1 mLsolvent in syringe)

Severe hypoglycaemia Adults and children >5 years: 1 mg SC, IM or IV

Children <5 years: 0.5 mg SC, IM or IV

Glyceryl trinitrate(400 microgram perdose, 200 doses assublingual spray)

Acute angina, acute leftventricular failure

Adults: 1–2 sprays under the tongue. Repeat after 5 minutesif needed (maximum 3 sprays).

Haloperidol(5 mg in 1 mLinjection)

Acute psychosis, severebehavioural disturbance

Adults: 2–10 mg IM (0.5–2 mg in the elderly)

Hydrocortisonesodium succinate(100mg or 250mgwith2 mL solvent forinjection)

Acute severe asthma Adults: 100mg IVChildren: 4mg/kg IV

Anaphylaxis Adults: 100 mg IV or IMChildren: 2–4 mg/kg IV

Acute adrenal insufficiency Adults: 100 mg IV or IMChildren 1–12 years: 50 mg IV or IMChildren 1–12 months: 25 mg IV or IM

Lignocaine(100mg in 5 mLinjection)

Sustained ventriculartachycardia

Lignocaine has serious adverse effects including the potentialto worsen arrhythmia and cardiac failure. Do not use outsideof hospital.

Adults and children: 1mg/kg IV over 1–2 minutes. Repeatafter 5 minutes if needed.

Metoclopramide(10 mg in 2 mLinjection)

Nausea and vomiting Adults: IV or IM>60 kg 10 mg starting dose30–59 kg 5 mg starting dose(maximum 0.5 mg/kg daily)

Not generally recommended in children as there is a risk ofextrapyramidal adverse effects

Methoxyflurane(3 mL plus inhaler)

Pain after acute trauma Adults and children (who are able to use the device, usually≥ 5 years): 6–8 breaths at a time (maximum 6 mL/day)

Morphine sulfate(15 mg or 30 mg in 1mL injection)

Severe pain Adults: SC or IM starting at lower dose<39 years 7.5–12.5 mg40–59 years 5–10 mg60–69 years 2.5–7.5 mg70–85 years 2.5–5 mg>85 years 2–3 mg

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Can also be given as IV increments of 0.5–2 mg titrated toeffect

Children >1 year and <50 kg: 0.05–0.1 mg/kg SC or IM

Naloxone(2 mg in 5 mLinjection)

Opioid overdose Adults and children: 0.4–0.8 mg IV, IM or SC repeated asnecessary

Neonates born with low APGAR scores to mothers takingopioids:0.1 mg/kg IV, IM or SC. Repeat if needed.

Procaine penicillin(1.5 mg in 3.4 mLinjection)

Severe infections (only suitablefor infections where prolongedlow concentrations areappropriate)

Adults: 1–1.5 g by deep IM injection

Children: 50 mg/kg by deep IM injection

Prochlorperazine(12.5 mg in 1 mLinjection)

Nausea and vomiting, vertigo Adults: 12.5 mg IM or IV

Promethazinehydrochloride(50 mg in 2 mLinjection)

Allergic reactions Adults and children >12 years: 25–50 mg IMChildren >2 years: 0.125 mg/kg IM

Nausea and vomiting Adults and children >12 years: 12.5–25 mg IM

Salbutamol inhaler(100 microgram perdose,200 doses)

Acute asthma, bronchospasm Adults and children: 4 puffs (400 microgram) via spacer.Repeat after 4 minutes if needed. If still no improvement,continue giving 4 puffs every 4 minutes until ambulancearrives.

Salbutamol nebulisersolution(2.5 mg or 5 mg in2.5 mL per dose, 30doses)

Acute asthma, bronchospasm Adults and children >2 years: 2.5–5mg by nebuliser asrequired

Children <2 years: 0.1 mg/kg up to 2.5 mg by nebuliser asrequired

For anaphylaxis give 5 mg by nebuliser to adults andchildren, repeat if required

Terbutaline(500 microgram in 1mL injection)

Acute asthma Adults: 250 microgram SC

Children: 5 microgram/kg SC

Tramadol(100 mg in 2 mLinjection)

Pain Adults: 50–100 mg IV over 2–3 minutes or IM

Verapamil(5 mg in 2 mLinjection)

Paroxysmal supraventriculartachycardia in patients who arenot:- taking beta blockers- having an infarction- in second or third degreeatrioventricular block

Do not use outside of hospital

Adults: 5 mg IV slowly (over at least 3 minutes), repeatafter 5–10 minutes if no response

Children: 0.1–0.3 mg/kg IV, repeat after 30 minutes if noresponse (maximum 5 mg)

* Pharmaceutical Benefits SchemeIM intramuscular IV intravenousSC subcutaneous

A guide to paediatric weights10 kg at 1–2 years15 kg at 2–3 years20 kg at 4–6 years 30 kg at 7–10 years

PBS* doctor's bag items for palliative care patients

These drugs should only be used after consultation with a palliative care specialist

DRUG INDICATION DOSE

Clonazepam(oral liquid containing25 mg in 10 mL)

Preventing seizures, hiccups Adults: 0.25–1 mg orally or sublingually

Hyoscine butylbromide(20 mg in 1 mL injection)

Noisy breathing and secretions Adults: 10–20 mg subcutaneously

1/17/13Emergency drug doses – PBS doctor’s bag items - Australian Prescriber

www.australianprescriber.com/magazine/35/1/25/7

PBS* Pharmaceutical Benefits Scheme

REFERENCES

1. Anaphylaxis: emergency management for health professionals [wall chart]. Aust Prescr 2011;34:124.2. National Asthma Council Australia. Asthma Management Handbook 2006.

www.nationalasthma.org.au/handbook

FURTHER READING

Holmes JL. Time to restock the doctor's bag. Aust Prescr 2012;35:7–9.

Baird A. Drugs for the doctor's bag. Aust Prescr 2007;30:143-6.

First published online: February - 2012